Diagnostic Approach to Vasculitis

Clinical Manifestations Should be suspected in any patient who presents with systemic symptoms in combination with evidence of single and/or multiorgan dysfunction. Common complaints and signs of vasculitis: fatigue, weakness, fever, arthralgias, abdominal pain, hypertension, renal insufficiency and neurologic dysfunction

Clinical Manifestations cont. Clinical manifestations can be mimicked by a number of other disorders, but there are certain signs that are highly suggestive of vasculitis Mononeuritis multiplex (PAN) Palpable purpura (alone- hypersensitivity vasculitis; w/ systemic organ involvement – HSP or microscopic polyangitis) Pulmonary + Renal involvement (Wegener’s or microscopic polyangitis)

Diagnostic Approach: 1. History Age and sex- Certain disorders occur among certain age groups and/or in women favoring the diagnosis of a specific vasculitic syndrome. A detailed history – administered drugs (hypersensitivity vasculitis) history of hepatitis (mixed cryoglobulinemia and polyarteritis) diagnosed with any disorder known to be associated with a vasculitis (such as systemic lupus erythematosus)

2. Physical Exam A careful physical examination helps to determine the extent of vascular lesions, the distribution of affected organs, and the presence of additional disease processes. certain findings, such as mononeuritis multiplex and palpable purpura, are highly suggestive of an underlying vasculitic process.

3. Laboratory Tests Determine the type of vasculitis, and the degree and types of organs affected Basic laboratory analysis should include serum creatinine and muscle enzyme concentrations, liver function studies, erythrocyte sedimentation rate, hepatitis serologies, urinalysis, chest x-ray, and electrocardiogram. Other tests that may be warranted include cerebrospinal fluid analysis, central nervous system imaging, pulmonary function testing, and blood and tissue culture. ANA (SLE) , Complement (mixed cryoglobulinemia and lupus ), ANCA (cANCA- Wegener’s; pANCA- microscopic polyangiitis )

4. Biopsy Blood tests, X–rays, and other studies may suggest the diagnosis of vasculitis, but biopsy examination of the most clinically involved tissue is essential for diagnosis skin, kidney, temporal artery, muscle, nasal mucosa, lung, sural nerve, and testis

5. Arteriograms Helpful to support a diagnosis when combined with other clinical data. Identifying and characterizing a vasculitis of large and medium-sized arteries Not helpful in assessing a small vessel vasculitis

References http://www.uptodate.com/contents/classification-of-and-approach-to-the-vasculitides-in-adults#H19